Week 3 reflection

Thank you for completing Week 3 of the course. To summarise, the aim of this week was to highlight the critical importance of leadership for the successful implementation of healthcare improvement. While knowledge of tools and techniques is a necessary starting point, change cannot occur without effective leadership which is sensitive to the context. In particular, we drew attention to the need to develop clinical leadership and also how, in healthcare settings, it is useful to view leadership as a shared endeavour.

To address these concerns, in this week we explored three main issues. First was to introduce you to the very extensive academic literature on leadership. As we saw, this literature has focused on defining leadership styles and how these may apply in different situations (so-called contingency theory). It also makes an important distinction between management and transformational forms of leadership which is concerned with setting a vision and influencing the culture of organisations. While it is important not to over-emphasise the role of great or heroic leaders, in healthcare there are many examples of where transformational leadership at the very top of organisations can make a difference.

A second concern explored in week three relates to the issue of clinical leadership. In recent years, there has been a growing enthusiasm for the goal of empowering doctors and other clinical professionals to take on leadership roles in the belief that these leaders are more likely to have the skills and credibility to initiate and drive change. Most recently Chris Ham from the King’s Fund referred to how clinical leadership has moved ‘from the dark side to centre stage’. We saw how there is now a growing body of (mainly quantitative) research supporting the idea that clinical leaders can improve service outcomes. This was also illustrated with examples from the English NHS. However, we also saw that developing clinical leaders was a very difficult task given competing demands and interests of clinical professionals.

Finally we looked at some alternative views about leadership which move away from the notion of individual or ‘heroic’ leaders to the idea that leadership activities are shared or distributed across teams or groups of professionals. The lecture by Graeme Currie set out the principles of this ‘distributed’ leadership and its particular relevance to healthcare. You also heard from Professor Rick Iedema about other ways of understanding leadership as a process of facilitating innovation within clinical teams.

These ideas highlight the need to understand leadership both as the responsibility of individuals and of a wider community of practitioners who may not take on formal management roles or even see themselves as ‘leaders’. They also point to the need for healthcare organisations to invest in developing these leadership capabilities as a necessary step towards improving services. In what follows we take this idea further by looking more closely at the tools and techniques of healthcare improvement and their implementation.